Treatment Of Intrabony Defects Research Articles

Evaluation of the effect of moringa oleifera gel and autologo platelet-rich fibrin in the treatment of rabbit intra bony defects. (Radio graphic and Histological study).

Periodontitis is the most common condition, which causes bony defects; the ultimate goal of periodontal therapy is the regeneration of the destroyed tissues. There is always a need to search for better biomaterials that can be used for the treatment of intrabony defects. This study evaluated the effect of Moringa oleifera (MO) gel and platelet-rich fibrin (PRF) in the treatment of bone defects. We hypothesized that MO gel may increase the bone mineral contents and density of bone. The study was conducted on 16 defects in 8 adult male rabbits divided into 2 groups; group (1) buccal bone defect treated with moringa hydrogel and PRF (right site), group (2) buccal bone defect treated with PRF (left site). Computed tomography (CT) radiography and histological examination were assessed at baseline, 14 and 28 days. The defects were induced in the form of one osseous wall defect between the 1st and the 2nd molars. Comparisons between groups were done using an unpaired t-test. For comparison within each group, analysis of variance (ANOVA) was used. CT radiograph results showed there was a significant increase in bone density at 28 days in group 1 than in group 2 (843.13 ± 97.82 to 713.0 ± 51.09). The histological result revealed the defect area on the (PRF + Moringa) was almost filled completely by newly formed bone with few spots of retarded calcification. While (PRF) showed complete filling of the defect area by more fibrous tissue. The healing score showed a significant elevation of bone defect healing score in (PRF + Moringa group) when compared to (PRF group) at both times of evaluation. Radiographical examination, and histological and healing scores confirmed the superiority of Moringa + PRF results in an increase in bone fill and density in induced periodontal intrabony defects regeneration. Clinical trials should be considered to detect the effectiveness of MO in intrabony defects.

Effectiveness of platelet rich fibrin alone or in combination with bone grafts in the treatment of infrabony defects: Systematic review and metanalysis

This systematic review aimed to investigate the effectiveness of PRF alone or in combination with bone grafts in enhancement of tissue/bone formation in infrabony defects. A search was performed in electronic databases (i.e. Pubmed/MEDLINE, EMBASE, Cochrane, Clinical trials.org) in order to identify Randomized Control Trials (RCTs). The last electronic search was run on 24 August 2021 From the search, 21 articles fulfilled the inclusion criteria and were quantitatively analyzed. In total, there were 13 articles with low risk of bias, 4 with some concerns and 4 with high risk. The meta-analysis showed that there was a statistically significant benefit from the use of PRF alone or in combination with bone graft after 6 months follow up in clinical attachment level (CAL), periodontal probing depth (PPD) and bone fill (BF). However, there was not a significant difference in CAL and PPD after 9 months In summary the use of PRF was effective in the treatment of periodontal infrabony defects especially in CAL and BF after 6 months follow up. From the interpretation of the results, we indicate that the combination of PRF with grafting materials may accelerate the bone healing process in the treatment of intrabony defects.

HISTOLOGICAL OUTCOMES AFTER REGENERATIVE PERIODONTAL THERAPY WITH EMDOGAIN

Objective: The aim of this study is to evaluate the histological and clinical outcomes of intrabony defects treatment using regenerative periodontal therapy with enamel matrix proteins (Emdogain, EMD). Material And Method:Ten patients with chronic periodontitis were included in this randomized, controlled clinical study. Two groups received conservative periodontal therapy. In the test group, different teeth received regenerative treatment with EMD. In the control group only conservative periodontal therapy was performed. The following parameters were recorded at baseline and after 8 months: pocket probing depth (PD) and histological examinations. Results:Both groups showed a significant reduction of PD. The teeth treated with EMD showed a significant attachment gain. Within the test group, the radiographic examination of the teeth treated with EMD showed no significant change, whereas the teeth in the control group showed significant bone reduction. Conclusion:Treatment of intrabony defects with EMD may lead to substantially higher gains in clinical attachment and defect filling. The use of EMD in dental practice can prevent further bone loss.

Clinical comparison of efficacy of Alloplast (Biograft HT) and PRF (Platelet Rich Fibrin) in the treatment of intrabony defects

Introduction: Clinical and Radiographic comparison of the efficacy of an alloplast (Biograft-HT®*) and Platelet rich fibrin (PRF) in the treatment of intrabony defects. Materials and Methods: A total number of 88 sites in 32 subjects were selected for the study and divided in two groups on basis of material use for treatment i.e platelet rich fibrin (PRF) and biograft-HT®. Results: The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical Analysis Software. At baseline there was no statistically significant difference between the groups. Conclusion: The comparison of PPD and CAL measurements between the two groups at different time intervals revealed no statistically significant difference. The defect fill and the percentage defect fill from 3 to 6 months was statistically significant in two groups.

Clinical Outcomes of Periodontal Regenerative Therapy Using rhFGF-2 with a Modified Minimally Invasive Surgical Technique for Intrabony Defects: Case Series with a 12-Month Follow-up.

The Modified Minimally Invasive Surgical Technique (M-MIST) was designed to improve wound stability and reduce patient morbidity. This case series aimed to evaluate clinical outcomes of periodontal regenerative therapy using recombinant human fibroblast growth factor (rhFGF)-2 with M-MIST for the treatment of intrabony defects. Following initial periodontal therapy, nine intrabony defects in seven patients received rhFGF-2 therapy. Using M-MIST, a buccal incision was made to gain access to the defect without interdental and lingual incisions. After debridement, rhFGF-2 was applied to the defect. Periodontal parameters were evaluated at baseline and at 3, 6, and 12 months postoperatively. Composite Outcome Measure (COM) and patient-reported outcome measure (PROM, recorded using an oral health-related quality of life [QoL] instrument) were also used for evaluation. At 12 months postoperative, mean probing depth reduction was 4.2 ± 0.8 mm and clinical attachment gain was 4.7 ± 0.7 mm. The mean value for gingival recession was -0.3 ± 0.5 mm. According to COM, the outcomes of the treated sites were successful. An improvement in oral health-related QoL was noted at 12 months compared to after the initial periodontal therapy. This case series shows that rhFGF-2 therapy with M-MIST yields favorable clinical outcomes in the treatment of intrabony defects.

Minimally invasive surgical techniques for the treatment of different types of isolated intrabony defects: A narrative review.

The aim of this literature review was to present minimally invasive surgical techniques (MISTs) for the regeneration of intrabony defects and the impact of these surgical procedures on clinical outcomes. Less invasive surgical procedures lead to a more uneventful postoperative healing and reduce patient morbidity. The introduction of these techniques together with the use of magnification tools enables gentle tissue manipulation with performing minimal incisions and flap elevations in the field of surgical treatment of intrabony defects. Minimally invasive surgical techniques induce minor surgical trauma and improve the wound stability with favorable results in terms of clinical outcomes and the patient's comfort. The defect anatomy, patient-centered factors and the various biomaterials applied are considered. Recent evidence concludes that the adjunctive use of regenerative materials seems to have a less determinant effect on the clinical performance of minimally invasive surgical techniques. In addition, more studies are required to investigate the clinical efficacy of these surgical techniques in the treatment of intrabony defects in comparison with the conventional papilla preservation flap techniques.

Predictability and Clinical Stability of Barrier Membranes in Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis

The adjunctive use of GTR membranes helps us to achieve predictable periodontal regeneration. The aim of this systematic review was to evaluate and compare the treatment efficacy of resorbable versus non-resorbable barrier membranes used in guided tissue regeneration in the treatment of intrabony defects in chronic periodontitis patients. The following databases were searched: Medline, the Cochrane Central Register of Controlled Trails (CENTRAL), SCOPUS, EMBASE. Randomized clinical trials (RCTs) published in English languages over the past 25 years were included. The primary outcomes assessed were: change of probing pocket depth (PD), change in clinical attachment level (CAL) and gingival recession coverage (GRC), and intrabony defect fill (IBDF). A total of eight RCTs were included for systematic review. The outcome of GR at a six-month interval revealed a significant difference in treatment effect with a mean difference of 0.42, 95% CI [0.02, 0.81]; Z = 2.09, (p = 0.04) favouring the resorbable membrane group. The intrabony defect depth fill at a 12-month interval revealed a significant difference in treatment effect with MD of 0.79, p = 0.00001; favoring the resorbable membrane group. The resorbable membrane showed a significant improvement in gingival recession coverage and intrabony defect fill, owing to its advantage of avoiding the second surgical intervention.

Modified minimally invasive surgical technique in human intrabony defects with or without regenerative materials-10-year follow-up of a randomized clinical trial: Tooth retention, periodontitis recurrence, and costs.

The modified minimally invasive surgical technique (M-MIST) optimizes wound stability in the treatment of intrabony defects. Short-term observations show similar results as with flap alone or adjunctive regenerative materials. This study aims to compare the stability of the long-term outcomes, complication-free survival, and costs of the three treatment options. Forty-five intrabony defects in 45 patients were randomized to M-MIST alone (N= 15), combined with enamel matrix derivative (M-MIST + EMD, N= 15), or EMD plus bone-mineral-derived xenograph (M-MIST + EMD + BMDX, N= 15). Supportive periodontal care (SPC) and necessary re-treatment were provided for 10 years. Three subjects were lost to follow-up. Clinical attachment level differences between 1 and 10 years were -0.1± 0.7 mm for M-MIST, -0.1± 0.8 mm for M-MIST + EMD, and -0.3± 0.6 mm for M-MIST + EMD + BMDX (p> .05 for within- and between-group differences). Four episodes of recurrence occurred in the M-MIST group, four in the M-MIST + EMD group, and five in the M-MIST + EMD + BMDX group. No significant differences in complication-free survival were observed between the three groups (p= .47). Complication-free survival was 7.46 years (95% confidence interval: 7.05-7.87) for the whole population. The M-MIST + EMD + BMDX group lost one treated tooth. Data indicated no significant inter-group difference of the total cost of recurrence over 10 years. When the baseline cost of treatment was considered, the total cost was lower for M-MIST alone. Teeth with deep pockets associated with intrabony defects can be successfully maintained over the long term with either M-MIST alone or by adding a regenerative material in the context of a careful SPC programme. M-MIST alone provided similar short- and long-term benefits as regeneration, at a lower cost. These findings need to be confirmed in larger, independent studies.

Comparative evaluation of the efficacy of amniotic membrane with collagen membrane along with demineralized freeze-dried bone allograft in the treatment of periodontal intrabony defects - A clinico-radiographic study.

The use of human-derived amniotic barrier membranes in regenerative procedures along with allograft like demineralized freeze-dried bone allograft (DFDBA) has displayed promising outcomes. The objective of the current research was to clinically and radiographically evaluate and compare amniotic membrane (AM) and collagen membrane (CM) in combination with open flap debridement (OFD) along with DFDBA in the management of human periodontal intrabony defects. The present research-based study was a randomized controlled clinical trial of 6 months duration. A total of twenty chronic periodontitis patients with intrabony defects were randomly divided into two groups: Group 1 treated with OFD + DFDBA + AM and Group 2 with OFD + DFDBA + CM. Clinical parameters such as plaque index (PI), gingival index (GI), pocket probing depth (PPD), and relative attachment level were recorded and evaluated at baseline, 3 months, and 6 months. The relative intrabony defect component level (rIBD) was recorded at baseline and after 6 months employing a millimeter X-ray grid. For comparison of clinical parameters and radiographic parameters at various intervals unpaired t-test, repeated measures ANOVA test, and paired t-test were used. The P value was taken statistically significant when less than 0.05 (P < 0.05). A statistically significant difference in PI, GI, PPD, and RAL for both the groups were found on intragroup comparison between baseline, 3 months, and 6 months (P < 0.05). On intragroup comparison, the difference in mean rIBD was statistically significant from baseline to 6 months. However, for all the clinical and radiographic parameters, no statistically significant difference was noted between both the groups (P > 0.05). In the treatment of intrabony defects AM being an allograft can be considered an alternative novel membrane for regenerative procedures.

Comparison of Laser-assisted and Conventional Flap Surgery with Hydroxyapatite Crystals in the Treatment of Intrabony Defects under Magnification- A Randomised Clinical Trial

Introduction: Achieving regeneration of the lost periodontal structures after surgical approach plays a major role. This healing can be interrupted due to the presence of invasive bacteria which is present in the periodontal tissues. Aim: To compare laser-assisted and conventional flap surgery using microsurgical instruments and under surgical operating microscope with hydroxyapatite graft in the treatment of intrabony defects. Materials and Methods: This prospective randomised split-mouth clinical study was conducted in Department of Periodontology at Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, from June 2020 to December 2021. A total of 24 bilateral intrabony defects were selected for the study. Control sites (n=12) received the graft after conventional open flap debridement. In the test group (n=12), graft placement was done followed by laser irradiation with diode laser (980 nm, power: 3.0 W; frequency 2.5 KHz) for 30 seconds. The entire flap surgery procedure was performed under Surgical Operating Microscope (SOM). Clinical parameters such as plaque index, gingival index, probing depth, relative attachment level, were assessed at 3 months and 6 months. Healing index was assessed after 7 days of surgery. Radiographic parameters were assessed at baseline and 6 months using Cone Beam Computed Tomography (CBCT). Descriptive statistics, Independent samples t-test, repeated measures analysis of variance and Paired t-tests were used in data analysis. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software. Results: Intragroup comparison showed statistical significance in all clinical and radiographical parameters (p-value&lt;0.001). Intergroup comparison between the test and control group did not show any statistical significance in terms of plaque index, gingival index, relative Clinical attachment level, probing depth (p-value≥0.05). Intragroup comparison of the depth of defect was statistically significant in both test (p-value=0.011) and control groups (p-values=0.002). Intergroup comparison did not show any statistical significance in linear bone fill (p-value=0.1). Intergroup comparison did not show any statistical significance in defect angle (p-value=0.773). No statistical significance was obtained in percentage fill (p-value=0.074). Intergroup comparison did not show any statistical significance in the clinical and radiographical parameters. Conclusion: The additional laser irradiation at the test site did not exhibit any significant benefits in the bone regeneration. All the outcomes were similar in test and control group.

Comparative effect of 1.2% atorvastatin gel and 1.2% rosuvastatin as a local drug delivery in treatment of intra-bony defects in chronic periodontitis.

The present study was aimed to evaluate the efficacy of 1.2% Atorvastatin (ATV) with 1.2% Rosuvastatin (RSV) as local drug delivery for treatment of Chronic Periodontitis (CP). Forty patients were equally divided into two groups. Group A underwent scaling and root debridement and 1.2% ATV gel (1.2 mg/0.1 mL) was placed, whereas group B received scaling and root debridement and RSV (1.2 mg/0.1 ml) was placed. The results showed that both the groups had improvement in all the recorded parameters, and the results obtained were statistically significant. When comparison was made between the groups, no significant difference was obtained between atorvastatin and rosuvastatin at baseline in all recorded parameters. However, after 6 months significant improvement was recorded in CAL (Clinical attachment level) and PD (Probing depth). The plaque index (PI) and gingival index (GI) score however showed improvement, but it did not attain the level of significance. The present study showed improvement in clinical parameters with the use of ATV and RSV gel when used in combination with scaling and root planing (SRP) in CP patients. Patients with RSV gel showed up significantly better than the ones in which ATV gel was placed.

Efficacy of Nanocrystalline Calcium Sulphate Bone Graft (Nanogen®) and Platelet Rich Fibrin in the Treatment of Periodontal Intrabony Defects: A Split Mouth Randomised Clinical Study

Introduction: Periodontal disease leads to the loss of supporting structures of the tooth. Recent years have witnessed the evolution of many regenerating materials that have shown to be effective in regenerating the loss structures. Aim: To evaluate and compare clinically and radiographically the efficacy of Platelet Rich Fibrin (PRF) and Nanocrystalline Calcium Sulphate Bone Graft (NanoGen®) in the treatment of intrabony defects. Materials and Methods: A split mouth randomised clinical study was done in the Department of Periodontology D.A.P.M.R.V. Dental College Bangalore from November 2018 to May 2020. In this study, 30 surgical sites were selected from 15 chronic periodontitis patients American Academy of Periodontology (AAP, 1999) of age between 35-65 years and with interproximal probing depth ≥5 mm following phase I therapy and radiographic evidence of intrabony defects ≥3 mm deep. They were divided into two groups: Group I (n=15) received open flap debridement with Nanocrystalline Calcium Sulphate (nCS) and Group II (n=15) open flap debridement with PRF. Clinical parameters assessed were Gingival Index (GI), Plaque Index (PI), Gingival Recession (GR), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). Intragroup was compared using Repeated Measures of ANOVA followed by Bonferroni's Post hoc Test and intergroup was compared using Independent Student Test. Results: Total 15 patients were selected in each group of which 10 were male and 5 were female patients. Mean age of the patients was 39.3 years. There was significant reduction in GI (p-value=0.04,PPD (p-value=0.04) and gain in CAL (p-value=0.04) in group I. The mean difference in CAL was also statistically significant in group II (p-value=0.01).The mean difference PI was not statistically significant between baseline and three months and baseline and six months in both groups. GR increased from baseline to three months and remained same at six months (p-value for group I and group II=0.36) in both groups. On intergroup comparison, group I (nCS) showed better improvement in clinical parameters like PPD (p-value=0.01), CAL (p-value=0.01) and BF (p-value=0.002) at all time intervals compared to group II (PRF). Conclusion: There was improvement in all clinical parameters except GR in both groups. So both can be used as regenerative materials. But based on this study nanocrystalline calcium sulphate bone graft can be preferred over PRF as a regenerative material.

Comparative Evaluation of Autogenous Bone Graft and Autologous Platelet-Rich Fibrin with and Without 1.2 mg in situ Rosuvastatin Gel in the Surgical Treatment of Intrabony Defect in Chronic Periodontitis Patients.

Context: Rosuvastatin (RSV) is a new synthetic, hydrophilic statin with potent anti-inflammatory and osseodifferentiation actions. Autogenous bone graft (ABG) is still considered the gold standard in reconstructive bone surgery. Addition of platelet-rich fibrin (PRF) to ABG provides sustained release of various growth factors and facilitates survival of the graft.Aims:The study aims to clinically and radiographically compare the effectiveness of ABG and PRF with and without 1.2 mg RSV gel in the surgical treatment of intrabony defect in chronic Periodontitis patient.Settings and Design: This was a randomized controlled clinical trial.Subjects and Methods: Thirty-nine patients (one site per participant) with chronic periodontitis were randomly divided into three groups: Group 1 (open flap debridement [OFD] + placebo), Group 2 (OFD + ABG + PRF), and Group 3 (OFD + ABG + PRF + 1.2 mg RSV). Relative attachment level (RAL) and probing pocket depth (PPD) were recorded at baseline, 3, 6, and 9 months. Radiographic measurements such as defect height (A and B) and defect width (C) were calculated at baseline and 9 months.Statistical Analysis Used: Intergroup comparison was done using Kruskal–Wallis ANOVA. An intragroup comparison was done using Friedman test and Wilcoxon signed-rank test.Results: The mean PPD reduction and mean RAL gain were highly significant in Group 3 and Group 2 than Group 1. For Group 3, a significant reduction of defect height and width and a significant amount of bone fill were achieved than Group 2 and Group 1.Conclusions: Addition of 1.2 mg RSV gel, PRF, and ABG has synergistic effects, explaining their role as a regenerative material in the treatment of intrabony defects.

Comparative Evaluation of Open Flap Debridement Therapy with Two Different Types of Platelet Concentrates, T-PRF and L-PRF as Adjuncts- A Systematic Review

Conventional Periodontal therapy such as scaling and root planing and open flap debridement aims to halt the inflammation process and promotes repair of disease-related defects. Current regenerative procedures offers a limited potential toward attaining a complete periodontal restoration and none is considered a gold standard in the treatment of intrabony defects. This study was done to compare the efficiency of Titanium-Platelet Rich Fibrin and Leukocyte-Platelet Rich Fibrin as adjuncts to Open Flap Debridement therapy to treat intra-bony periodontal defects. A search was conducted through PubMed and various other databases such as Cochrane, Google Scholar and EBSCO Host , under the key words, OFD , T-PRF,L-PRF, Clinical Outcomes, Comparison and Randomised Contolled Trials. Six relevant articles were selected for analysis. Compared to non-platelet concentrates, L-PRFproves to be the better adjunct to open flap debridement therapy. When compared to T-PRF, however, L-PRF has comparatively inferior properties of bone defect resolution and fill.We can conclude that T-PRF has better properties, greater bone defect fill and defect resolution as compared to L-PRF.

Efficacy of a new-generation platelet-rich fibrin in the treatment of periodontal intrabony defects: a randomized clinical trial

BackgroundThe aim of the study was to clinically evaluate the healing of intrabony defects after treatment with a new generation of platelet-rich fibrin (A-PRF+) respect to enamel matrix derivative (EMD).MethodsThirty (30) intrabony defects of 18 patients (9 males, 9 females) were randomly treated with A-PRF+ (test, n = 15) or EMD (control, n = 15). The following clinical parameters were recorded at baseline and 6 months after surgery: pocket depth (PD), gingival recession (GR) and clinical attachment level (CAL). After debridement the intrabony defects were filled with A-PRF+ in the test group, respectively with EMD in the control group, and fixed with sutures to ensure wound closure and stability.ResultsBoth treatment methods resulted in statistically significant PD reductions, respectively CAL gains six months post-operatively. No statistically significant differences were found between the two groups as the mean CAL gain was 2.33 ± 1.58 mm in the A-PRF+ group, respectively 2.60 ± 1.18 mm in the EMD group (p < 0.001).ConclusionWithin the limits of this study the new-generation platelet-rich fibrin seems to be as clinically effective as EMD during surgical treatment of intrabony defects. Treatment with A-PRF+ or EMD resulted in reliable clinical outcomes. The use of A-PRF+ as a human autologous product can give a positive impact on periodontal healing.Clinical Relevance A-PRF+ may be suitable for the treatment of intrabony periodontal defects.Trial registration number (TRN) NCT04404374 (ClinicalTrials.gov ID).

Treatment of Intrabony Defects with a Combination of Hyaluronic Acid and Deproteinized Porcine Bone Mineral.

Background: this study evaluates the clinical outcomes of a novel approach in treating deep intrabony defects utilizing papilla preservation techniques with a combination of hyaluronic acid (HA) and deproteinized porcine bone mineral. Methods: 23 patients with 27 intrabony defects were treated with a combination of HA and deproteinized porcine bone mineral. Clinical attachment level (CAL), pocket probing depth (PPD), gingival recession (REC) were recorded at baseline and 6 months after the surgery. Results: At 6 months, there was a significant CAL gain of 3.65 ± 1.67 mm (p < 0.001) with a PPD reduction of 4.54 ± 1.65 mm (p < 0.001), which was associated with an increase in gingival recession (0.89 ± 0.59 mm, p < 0.001). The percentage of pocket resolution based on a PPD ≤4 mm was 92.6% and the failure rate based on a PPD of 5 mm was 7.4%. Conclusions: the present findings indicate that applying a combined HA and xenograft approach in deep intrabony defects provides clinically relevant CAL gains and PPD reductions compared to baseline values and is a valid new approach in treating intrabony defects.

Enamel matrix derivative as an adjunct to minimally invasive non-surgical treatment of intrabony defects: A randomized clinical trial.

To compare the efficacy of minimally invasive non-surgical technique (MINST) with or without enamel matrix derivative (EMD) in the treatment of intrabony defects ≤7 mm. Thirty-six patients were randomly assigned to the two groups. The control group received MINST, while the experimental MINST+EMD. Clinical measurements were recorded at baseline and at 6 and 12 months, and radiographic measurements were made at baseline and 12 months. All subjects completed the study, 18 in each group. Significant improvements were observed in both groups at 12 months (p < .001) with no differences in mean PD reduction (4.0 ± 1.4vs. 4.2 ± 1.7 mm), CAL gain (3.5 ± 1.4 vs. 3.4 ± 1.6 mm), and defect resolution (1.9 ± 1.1 vs. 1.8 ± 0.9 mm) for the MINST and the MINST+EMD groups, respectively (p > .05). A trend for greater pocket closure (PD ≤4 mm and no BoP) was achieved with the application of EMD (77.8% vs. 55.6% sites), particularly for sites with baseline PD ≤8 mm (92.3% vs. 69.2% sites), accompanied by an increased number of successful composite outcome results (61.1% vs. 44.4% sites). MINST demonstrates significant improvements 12 months after treatment of intrabony defects ≤7 mm. The additional application of EMD does not further improve the mean clinical or radiographic outcomes. This study is registered in ClinicalTrials.gov (NCT03622255).

Treatment of intrabony periodontal defects in controlled diabetic patients with an enamel matrix derivative: a split-mouth randomized clinical trial.

This split-mouth randomized controlled trial aimed to evaluate the effect of enamel matrix derivative (EMD) associated with a simplified papilla preservation flap (SPPF) compared to SPPF alone in the surgical treatment of intrabony defects (ID) in type 2 diabetic mellitus (T2DM) patients. Thirteen patients with controlled T2DM presenting with ID in at least two quadrants were included. In each patient, the test site (TS) was treated with SPPF plus EMD, whereas the control site (CS) was treated only with SPPF. Prior to surgery and at 6months after intervention, the following parameters were evaluated: clinical attachment level (CAL), probing pocket depth (PPD), and gingival recession (GR). The TS and CS demonstrated a mean CAL gain of 3.31 ± 0.96mm and 1.61 ± 1.12mm, and a PPD reduction from 8.15 ± 0.98 to 3.00 ± 0.57mm and 7.53 ± 0.96 to 4.69 ± 0.63mm after 6months, respectively. In both sites, the mean CAL gain and PPD reduction improved significantly after 6months compared to baseline; however, the improvement was higher in the TS (p < 0.001). Both surgical procedures presented with clinical improvements in controlled T2DM patients. However, the additional use of EMD showed enhanced clinical results after 6months with regard to CAL gain and PPD reduction. This study showed a better PPD reduction and CAL gain when an EMD was applied in addition to SPPF. Therefore, EMD may be used to enhance clinical outcomes in periodontal ID of controlled T2DM patients.

Beta-Tricalcium Phosphate and Concentrated Growth Factors in Treatment of Intra-bony Defect Randomized Clinical Trial (RCT)

This study was designed to assess the efficacy of biodegradable gelatin / Beta-tricalcium phosphate sponge socked in concentrated growth factors (CGF) in treating periodontal intra-bony defects, as compared with biodegradable gelatin /beta-tricalcium phosphate sponges alone. Materials and Methods: Twenty intra-bony defects ≥4 mm and pocket depth (PD) ≥5 mm in 20 patients were selected from the outpatient clinic of Oral Periodontology Clinic, Faculty of Dentistry, Tanta University to join in this study. Patients were randomly allocated into two groups 10 patients each. Group I was treated by surgery plus biodegradable gelatin /beta-tricalcium phosphate sponges, (control group). Group II was treated by gelatin/beta-tricalcium phosphate sponges socked in CGF. Bleeding on probing (BOP), PD, and clinical attachment level (CAL) were measured at baseline, 3, and 6months periods. Cone beam radiographs were taken at baseline, and 6 months after surgery evaluating the area of the defect (AD) and bone density (BD). Results: Both groups showed significant improvement in clinical parameters (P≤0.05). There were statistically significant differences in all investigated parameters between the two groups at 3 and 6 months in favor of group II, except for CAL there was no significant difference between them at 6 months. A significant decrease of DA and increase in BD at 6 months was noted for both groups with significant differences between them in favor of group II (P<0.05). Conclusion: Using a biodegradable gelatin/β-TCP socked in CGF could enhance the outcome of periodontal regeneration, as evidenced by improved bone density and reduction in the defect area.

EVALUATION OF EFFICACY OF DEMINERALIZED FREEZE DRIED BONE ALLOGRAFT WITH AND WITHOUT PLATELET-RICH FIBRIN IN THE TREATMENT OF INTRABONY DEFECTS BY CONE BEAM COMPUTED TOMOGRAPHY: A CLINICAL AND RADIOGRAPHIC STUDY

Background: Eventhough the combination of DFDBA (demineralized freeze dried bone allograft) with PRF (platelet-rich fibrin) has been attempted in periodontal practice with significant results, assessment of the intrabony defect and defect bone fill largely done with two-dimensional imaging modalities. Three dimentional analysis of the intrabony defect and defect bone fill has not been attempted with cone beam computer tomography (CBCT). The present study evaluated the efficacy of DFDBA with and without PRF in the treatment ofintrabony defects by CBCT. Methods: 60 defects in systemically healthy patients ranging from 18 to 50 years of age will be included in the study.30 defects were treated with PRF+DFDBA and 30 defects were treated with DFDBA alone. The study will include the assessment of clinical parameters involving probing depth (PD), relative attachment level(RAL), full mouth bleeding scores(FMBS),plaque index and gingival index from baseline to 3 , 6, 9 months. Hard tissue changes will be assessed radiographically by evaluating defect fill and defect resolution by CBCT at baseline&amp; 9 months. Results: The results of the present study are statistically significant in both groups in terms of clinical and radiographical parameters (P &lt; 0.001). In inter-group comparison, there was a statistically significant greater PD reduction and attachment gain while there was not significant reduction in terms of PI, GI, FMBS, defect fill and defect resolution in DFDBA+ PRF group. Conclusion: DFDBA along with PRF failed to provide additional value in terms of defect fill and defect resolution over DFDBA alone.